Friday, April 13, 2012

H1N1 Influenza in India: No Cause for Panic

The situation with respect to instances of H1N1 in India is well under control and is being monitored. As reported in some section of the press, the virus has not mutated to a more virulent form or changed its character.

According to the Health ministry release, the Director, National Institute ofVirology, Pune has clarified that the presently circulating strain of H1N1 pandemic virus belongs to clade 6 and 7. (Clade is the medical terminology used to describe related organisms descended from a common ancestor). These clades are circulating in many countries and all are treatable with Oseltamivir, an antiviral drug, which slows the spread of the influenza causing virus.

The currently available vaccine can be used as an antigenic; antigen is a substance that when introduced into the body stimulates the production of an antibody. Antigens include toxins, bacteria, foreign blood cells, and the cells of transplanted organs. Currently, there is no mutation to suggest change of virus to 'dangerous form'.

The World Health Organization while declaring the Pandemic as over in August 2010, had conveyed that the influenza H1N1 pandemic virus would take on the behaviour of seasonal influenza virus, and continue to circulate for some years to come. Hence, in the post-pandemic period, localized outbreaks of varying magnitude with significant level of H1N1 transmission are expected.

Subsequent to this declaration, India had experienced major outbreaks during the period August to October, 2010 and again from May, 2011 to July 2011. In March-April, 2012, there is  an increased number of cases of Pandemic Influenza A H1N1 reported from the State of Andhra Pradesh, Maharashtra, Rajasthan, Karnataka and Tamil Nadu.

Small pockets of populations which remained unexposed to the pandemic stand the chance of being  susceptible and may be affected. In first week of March almost 30% of referred samples were positive for H1N1 in Pune which has come down to approx. 10% now.

A large number of these cases would be presenting with mild influenza like illness and as such requires no testing or anti viral drug treatment. However, it is important to get oneself examined at the nearest hospital in the initial part of illness to detect moderate illness and other associated risk factors/ diseases that require hospitalization, the ministry's release has pointed out.

The anti viral drug Oseltamivir is available free of cost through the State public health system. They are also available with retail chemists licensed to keep Schedule X drugs. A central stockpile of about 8 million doses of Oseltamivir is also maintained. As the virus is circulating within the country, there is no need to impose any travel restrictions or screening at inter-state point of entry, railway stations etc.

Committee of Secretaries Reviews State of Preparedness to Contain H1N1

The Cabinet Secretary, Ajit Kumar Seth, chaired on 12th March, a meeting of the Committee of Secretaries to review the state of preparedness to contain the incidence of H1N1 virus. Secretaries from Ministry of Health and Family Welfare, Biotechnology, Pharmaceuticals were among those who attended the meeting.

The Cabinet secretary was apprised that a central team was deputed to Pune on April 8, 2012 to investigate the outbreak of Influenza A H1N1 and their preliminary report shows that the cases and deaths reported from Pune and Pimpri-Chinchiwad are sporadic in nature.

 A central stockpile of Oseltamivir tablets (anti viral drug) is being maintained and Department of Pharmaceuticals is monitoring availability of raw ingredient for making the drug. There is adequate stock of drugs and vaccines for treatment of people affected by the illness and immunization of health care personnel and whosoever may require it. Vaccine manufactured by indigenous manufacturers is also available.

The medical response system has been put on a state of preparedness. Forty five laboratories are testing samples (26 in Government sector and 19 in Private Sector). The test is done free of cost in Government laboratories/Integrated Disease Surveillance Project supported private laboratories (KMC, Manipal and CMC, Vellore). A nationwide network of laboratories in the private sector are also available for rapid diagnosis.

It was also stated that at the time of the early warning of the cases in Pune itself, an advisory was sent to all the States and Union Territories about the possibility of sporadic outbreaks of H1N1 influenza. Owing to reports circulating in the media regarding mutation in the virus, expert opinion was sought from the Director, National Institute of Virology, Pune who has stated that there is no mutation to suggest change of virus to ‘dangerous form’.

The present strain of H1N1 pandemic virus are susceptible to Oseltamivir and the currently available vaccine can be used for protection against the virus. In the first week of March almost 30% of referred samples were positive for H1N1 in Pune which has now come down to approximately 10%.

During the period from March 1, 2012 to April 9, 2012, 689 cases of H1N1 have been reported from Maharashtra (392 cases), Karnataka (104), Andhra Pradesh (66), Rajasthan (84), Tamil Nadu (28), Delhi (6), Gujarat (5) and in Punjab, Haryana, Himachal Pradesh and Madhya Pradesh (one each). During the same period, 35 deaths have been reported, of which 15 were from Maharashtra, nine from Rajasthan, six from Andhra Pradesh, two from Gujarat and one each from Tamil Nadu, Himachal Pradesh and Madhya Pradesh.

Ministry of Health & Family Welfare has been asked to monitor the situation on a day to day basis and take all possible steps to ensure that the drug and vaccine are available in sufficient stock.

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